Case: Vascular Encasement of Meningioma With Absent Vasogenic Edema
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So as I've been pontificating here
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about syndromic meningioma,
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you've been looking at the more
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important practical things,
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and what's the thing that strikes you that's
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most important regarding this meningioma?
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So the most important thing regarding this meningioma
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is its relationship to the surrounding structures.
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In this case,
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it actually encases the left internal carotid artery.
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I'm going to put an arrow on the carotid artery,
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and you can see how it's narrowed right there.
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On the other side, not so much.
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And then I'm going to take that away,
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and then I'm going to actually draw over the tumor
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so you can see the tumor very nicely.
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The tumor is this gray structure right here.
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And what do you think about the amount of
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edema that the central tumor elicits?
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Do you think there's any brain or parenchymal vasogenic edema?
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So that's the interesting thing about this case,
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is there is no surrounding vasogenic edema.
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As he pulls down the FLAIR sequence
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on the far right panel,
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the tumor is relatively large,
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and there is no surrounding vasogenic edema.
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Yeah, when we were discussing this offline,
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I mentioned to Dr. Laser, I thought,
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there is a little bit of vasogenic
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edema right behind here,
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but I was simply looking at a cleft of CSF that
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was displaced, not real vasogenic edema.
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And you pointed out correctly that, hey,
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you got to go look at the FLAIR to see if there really is any.
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Now, on the flip side,
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if there was a lot of vasogenic edema,
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that wouldn't bother me so much.
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Although I will say that the skull-based ones,
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even though they're fibrovascular and they grow in
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a very serpiginous, difficult way to remove,
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you don't see as much vasogenic edema
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with the ones that are down low,
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where you see big-time vasogenic edema are the
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ones in the convexity and the upper falx.
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But again, you and I discussed before,
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lots of young residents and attendings will see these
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big meningiomas with tremendous vasogenic edema,
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and they go after glioblastoma multiforme,
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ignoring the tenet of, is it intraaxial or extraaxial?
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So don't be misled.
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Big meningiomas can have plenty of vasogenic edema.
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I think we're ready to move on to another one.
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Let's do it.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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